Method of Inhibiting Inflammatory Pain

ABSTRACT

A method of treating or inhibiting, in particular, pain caused by inflammation in a mammal by administering to the mammal an effective inflammatory pain alleviating amount of a (1R,2R)-3-(2-dimethylaminomethyl-cyclohexyl)-phenol compound or a physiologically acceptable salt thereof, such as the hydrochloride or citrate salt.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a division of application Ser. No. 11/133,190, filed May 20, 2005, now U.S. Pat. No. ______, which in turn was a continuation of International Patent Application No. PCT/EP2003/012882, filed Nov. 18, 2003, designating the United States of America, and published in German as WO 2004/047823 A1, the entire disclosure of which is incorporated herein by reference. Priority is claimed based on German Patent Application Nos. 102 54 785.8, filed Nov. 22, 2002, and 103 26 103.6, filed Jun. 6, 2003.

FIELD OF THE INVENTION

The invention relates to a method of treating or inhibiting pain, particularly pain caused by inflammation or inflammatory pain.

BACKGROUND OF THE INVENTION

The treatment of chronic and non-chronic pain conditions is extremely important in medicine. There is currently a worldwide demand for additional, not exclusively opioid-based, but highly effective, pain treatment. The urgent need for action for patient-oriented and purposeful treatment of chronic and non-chronic pain conditions, this being taken to mean the successful and satisfactory treatment of pain for the patient, is documented in the large number of scientific papers which have recently appeared in the field of applied analgesics and fundamental research work on nociception.

Even if the analgesics that are conventionally used for treating pain, for example opioids, NA- and 5HT-reuptake inhibitors, NSAIDS and also COX inhibitors, are analgesically effective, side effects nevertheless sometimes occur, in particular in the case of the more active opioids.

SUMMARY OF THE INVENTION

The object of the present invention is therefore to provide a new method for treating, in particular, inflammatory pain or pain due to inflammation.

It has been found that (1R,2R)-3-(2-dimethylaminomethyl-cyclohexyl)-phenol or a physiologically acceptable salt thereof is outstandingly effective for treating or inhibiting inflammatory pain.

Accordingly, the invention relates to a method of treating or inhibiting inflammatory pain in a mammal in need thereof, comprising administering to said mammal a pharmacologically effective amount of or a physiologically acceptable salt thereof. Particularly preferred salts are the hydrochloride salt and the citrate salt.

The active substance may be administered as a racemate or, optionally, in the form of a pure stereoisomer, in particular enantiomer or diastereomer, or in the form of a mixture of stereoisomers, in particular the enantiomers or diastereomers, in any mixing ratio. The active substance may also be administered in the form of a solvate, in particular a hydrate.

The active substance corresponds to a compound of the following formula III

in which X is hydrogen;

one of R¹⁰ and R¹² is OH, and

R⁹, R¹¹, R¹³ and the other of R¹⁰ and R¹² are each hydrogen.

In the context of this invention, alkyl and cycloalkyl radicals are taken to mean saturated and unsaturated (but not aromatic), branched, unbranched and cyclic hydrocarbons which may be unsubstituted or singly or multiply substituted. In this case C₁₋₂ alkyl represents C1 or C2 alkyl, C₁₋₃ alkyl represents C1, C2 or C3 alkyl, C₁₋₄ alkyl represents C1, C2, C3 or C4 alkyl, C₁₋₅ alkyl represents C1, C2, C3, C4 or C5 alkyl, C₁₋₆ alkyl represents C1, C2, C3, C4, C5 or C6 alkyl, C₁₋₇ alkyl represents C1, C2, C3, C4, C5, C6 or C7 alkyl, C₁₋₈ alkyl represents C1, C2, C3, C4, C5, C6, C7 or C8 alkyl, C₁₋₁₀ alkyl represents C1, C2, C3, C4, C5, C6, C7, C8, C9 or C10 alkyl and C₁₋₁₈ alkyl represents C1, C2, C3, C4, C5, C6, C7, C8, C9, C10, C11, C12, C13, C14, C15, C16, C17 or C18 alkyl. Furthermore C₃₋₄ cycloalkyl represents C3 or C4 cycloalkyl, C₃₋₅ cycloalkyl represents C3, C4 or C5 cycloalkyl, C₃₋₆ cycloalkyl represents C3, C4, C5 or C6 cycloalkyl, C₃₋₇ cycloalkyl represents C3, C4, C5, C6 or C7 cycloalkyl, C₃₋₈ cycloalkyl represents C3, C4, C5, C6, C7 or C8 cycloalkyl, C₄₋₅ cycloalkyl represents C4 or C5 cycloalkyl, C₄₋₆ cycloalkyl represents C4, C5 or C6 cycloalkyl, C₄₋₇ cycloalkyl represents C4, C5, C6 or C7 cycloalkyl, C₅₋₆ cycloalkyl represents C5 or C6 cycloalkyl and C₅₋₇ cycloalkyl represents C5, C6 or C7 cycloalkyl. With respect to cycloalkyl, the term also comprises saturated cycloalkyls, in which one or two carbon atoms are replaced by a heteroatom, S, N or O. However, the term cycloalkyl also includes singly or multiply, preferably singly, unsaturated cycloalkyls without a heteroatom in the ring, if the cycloalkyl is not an aromatic system. The alkyl and cycloalkyl radicals are preferably methyl, ethyl, vinyl (ethenyl), propyl, allyl (2-propenyl), 1-propinyl, methylethyl, butyl, 1-methylpropyl, 2-methylpropyl, 1,1-dimethylethyl, pentyl, 1,1-dimethylpropyl, 1,2-dimethylpropyl, 2,2-dimethylpropyl, hexyl, 1-methylpentyl, cyclopropyl, 2-methylyclopropyl, cyclopropylmethyl, cyclobutyl, cyclopentyl, cyclopentylmethyl, cyclohexyl, cycloheptyl, cyclooctyl, but also adamantyl, CHF₂, CF₃ or CH₂OH and pyrazolinone, oxopyrazolinone, [1,4]dioxan or dioxolan.

In this case, in conjunction with alkyl and cycloalkyl—unless this is not explicitly defined otherwise—the term substituted in the context of this invention denotes the substitution of at least one (optionally also more) hydrogen radical(s) for F, Cl, Br, I, NH₂, SH, OCH₃, SCH₃, N(CH₃)₂, NHCH₃ or OH, wherein “multiply substituted” or “substituted” with multiple substitution denotes that the substitution is made both on different and on the same atoms multiply with the same or different substituents, for example threefold on the same carbon atom as in the case of CF₃ or at different points as in the case of —CH(OH)—CH═CH—CHCl₂. Particularly preferred substituents in this case are F, Cl and OH. With respect to cycloalkyl, the hydrogen radical can also be replaced by OC₁₋₃ alkyl or C₁₋₃ alkyl (singly or multiply substituted or unsubstituted respectively), in particular methyl, ethyl, n-propyl, i-propyl, CF₃, methoxy or ethoxy.

The term (CH₂)₃₋₆ is taken to mean —CH₂—CH₂—CH₂—, —CH₂—CH₂—CH₂—CH₂—, —CH₂—CH₂—CH₂—CH₂—CH₂— and CH₂—CH₂—CH₂—CH₂—CH₂—CH₂—, (CH₂)₁₋₄ to mean —CH₂—, —CH₂—CH₂—, —CH₂—CH₂—CH₂— and —CH₂—CH₂—CH₂—CH₂—, (CH₂)₄₋₅ to mean —CH₂—CH₂—CH₂—CH₂— and —CH₂—CH₂—CH₂—CH₂—CH₂—, etc.

An aryl radical denotes ring systems with at least one aromatic ring but without heteroatoms even in only one of the rings. Examples are phenyl, naphthyl, fluoroanthenyl, fluorenyl, tetralinyl or indanyl, which can be unsubstituted or singly or multiply substituted.

A heteroaryl radical denotes heterocyclic ring systems with at least one unsaturated ring, which contain one or more heteroatoms from the group comprising nitrogen, oxygen and/or sulfur and which can also be singly or multiply substituted. Examples from the group of heteroaryls include furan, benzofuran, thiophene, benzothiophene, pyrrole, pyridine, pyrimidine, pyrazine, quinoline, isoquinoline, phthalazine, benzo[1,2,5]thiadiazole, benzothiazole, indole, benzotriazole, benzodioxolan, benzodioxan, carbazole, indole and quinazoline.

In this case, in conjunction with aryl and heteroaryl, substituted denotes the substitution of the aryl or heteroaryl by R²², OR²², a halogen, preferably F and/or Cl, a CF₃, a CN, a NO₂, a NR²³R²⁴, a C₁₋₆ alkyl (saturated), a C₁₋₆ alkoxy, a C₃₋₈ cycloalkoxy, a C₃₋₈ cycloalkyl or a C₂₋₆ alkylene. In this case R²² represents H, a C₁₋₁₀ alkyl, preferably a C₁₋₆ alkyl, an aryl or heteroaryl radical or an aryl or heteroaryl radical bound by C₁₋₃ alkyl, saturated or unsaturated, or a C₁₋₃ alkylene-group-bound aryl or heteroaryl radical, wherein these aryl or heteroaryl radicals must not themselves be substituted by aryl or heteroaryl radicals, R²³ and R²⁴, which may be the same or different, represent H, a C₁₋₁₀ alkyl, preferably a C₁₋₆ alkyl, an aryl radical, a heteroaryl radical or an aryl or heteroaryl radical bound by saturated or unsaturated C₁₋₃ alkyl or a C₁₋₃ alkylene-group-bound aryl or heteroaryl radical, wherein these aryl or heteroaryl radicals must not themselves be substituted by aryl or heteroaryl radicals, or R²³ and R²⁴ together mean CH₂CH₂OCH₂CH₂, CH₂CH₂NR²⁵CH₂CH₂ or (CH₂)₃₋₆, and R²⁵ represents H, a C₁₋₁₀ alkyl, preferably a C₁₋₆ alkyl, an aryl radical, a heteroaryl radical or an aryl or heteroaryl radical bound by saturated or unsaturated C₁₋₃ alkyl or a C₁₋₃ alkylene-group-bound aryl or heteroaryl radical, wherein these aryl or heteroaryl radicals must not themselves be substituted by aryl or heteroaryl radicals.

The term “salt” denotes any form of the active ingredient according to the invention in which it assumes or is charged with an ionic form and is coupled to a counter ion (a cation or anion) or is in solution. This also includes complexes of the active ingredient with other molecules and ions, in particular complexes which are complexed by ion interaction. In particular this is taken to mean (and this is also a preferred embodiment of this invention) physiologically acceptable salts, in particular physiologically acceptable salts with cations or bases and physiologically acceptable salts with anions or acids or even a salt formed with a physiologically acceptable acid or physiologically acceptable cation.

The “term physiologically acceptable salt with anions or acids” denotes, in the context of this invention, salts of at least one of the compounds according to the invention—usually protonated, for example on nitrogen—as a cation with at least one anion which are physiologically acceptable—in particular when administered to humans and/or mammals. In the context of this invention this denotes, in particular, the salt formed with a physiologically acceptable acid, namely salts of the respective active ingredient with inorganic or organic acids, which are physiologically acceptable—in particular when administered to humans and/or mammals. Examples of physiologically acceptable salts of specific acids are salts of: hydrochloric acid, hydrobromic acid, sulfuric acid, methane sulfonic acid, formic acid, acetic acid, oxalic acid, succinic acid, malic acid, tartaric acid, mandelic acid, fumaric acid, lactic acid, citric acid, glutamic acid, 1,1-dioxo-1,2-dihydro1b6-benzo[d]isothiazol-3-one (saccharic acid), monomethyl sebacic acid, 5-oxo-proline, hexane-1-sulfonic acid, nicotinic acid, 2-, 3- or 4-amino benzoic acid, 2,4,6-trimethyl-benzoic acid, α-lipoic acid, acetyl glycine, acetylsalicylic acid, hippuric acid and/or aspartic acid. Hydrochloride salt and citrate are particularly preferred.

The term “salt formed with a physiologically acceptable acid”, according to this invention, is taken to mean salts of the respective active ingredient with inorganic or organic acids which are physiologically acceptable—in particular when administered to humans and/or mammals. Hydrochloride and citrate are particularly preferred. Examples of physiologically acceptable acids include: hydrochloric acid, hydrobromic acid, sulfuric acid, methane sulfonic acid, formic acid, acetic acid, oxalic acid, succinic acid, tartaric acid, mandelic acid, fumaric acid, lactic acid, citric acid, glutamic acid, 1,1-dioxo-1,2-dihydro-1b6-benzo[d]isothiazol-3-one (saccharic acid), monomethyl sebacic acid, 5-oxo-proline, hexane-1-sulfonic acid, nicotinic acid, 2-, 3- or 4-amino benzoic acid, 2,4,6-trimethyl-benzoic acid, α-lipoic acid, acetyl glycine, acetylsalicylic acid, hippuric acid and/or aspartic acid. Hydrochloride salt and citrate are particularly preferred.

The term “physiologically acceptable salt with cations or bases” denotes, in the context of this invention, salts of at least one of the compounds according to the invention—usually a (deprotonated) acid—as an anion with at least one, preferably inorganic, cation, which are physiologically acceptable, in particular when administered to humans and/or mammals. The salts of the alkali and alkaline-earth metals are particularly preferred, but also NH₄ ⁺, in particular however (mono) or (di) sodium, (mono) or (di) potassium, magnesium or calcium salts.

The term “salt formed with a physiologically acceptable cation” is taken to mean, in the context of this invention, salts of at least one of the respective compounds as an anion with at least one inorganic cation, which are physiologically acceptable, in particular when administered to humans and/or mammals. The salts of the alkali and alkaline-earth metals are particularly preferred, but also NH₄ ⁺, in particular however (mono) or (di) sodium, (mono) or (di) potassium, magnesium or calcium salts.

3-(2-dimethylaminomethyl-cyclohexyl)-phenol compounds and the production thereof are known from U.S. Pat. No. 5,733,936 (=DE 195 25 137).

The term “COX-II inhibitors” refers to selective inhibitors of COX II, the inducible isoform of cyclooxygenase. Cyclooxygenase is a synonym for prostaglandin endoperoxide synthase; an enzyme that combines the function of a dioxygenase and a peroxidase and, as a key enzyme, catalyses the conversion of arachidonic acid into prostaglandin H2 or peroxides (see Walter de Gruyter, Pschyrembel, 258^(th) edition; Roche Lexikon Medizin, 4^(th) edition). Further information regarding COX-II inhibitors, in particular listings thereof, may be found on pp. 13 to 126 and in particular 21 to 31 of “Analgesics, From Chemistry and Pharmacology to Clinical Application”; Buschmann et al (eds.), 1^(st) edition, Wiley-VCH, 2002. All of the content of this chapter is part of the description of this invention. The term “COX-II inhibitors” refers in particular, by way of example, to Celecoxib, Rofecoxib, Etoricoxib, Valdecoxib, Parecoxib, Etodolac, Meloxicam or Nimesulide. Celecoxib, which is sold under the name LOSEC® or Prilosec® or CELEBREX®, and Rofecoxib, which is sold under the name VIOXX®, are of particular importance. The term “selectively correspondingly preferred” denotes that the compound displays more pronounced inhibition of COX II than of COX I and/or in particular exhibits an IC₅₀ that is ≧5 lower on COX II than on COX 1.

In particular, the actived compound may be in the form of the diastereomers having the relative configuration IIIa

and may be used as a mixture having a relatively high content of this diastereomer in comparison to the other diastereomer, or it may be used as a pure diastereomer. In particular, the active compound may advantageously be (−)-(1R,2R)-3-(2-dimethylaminomethyl-cyclohexyl)-phenol or a salt thereof with a physiologically tolerable acid, e.g. hydrochloric acid or citric acid.

In a preferred embodiment, for the active substance according to the invention may be co-administered with a COX-II inhibitor selected from the group consisting of Celecoxib, Rofecoxib, Etoricoxib, Valdecoxib, Parecoxib, Etodolac, Meloxicam and Nimesulide, in particular Celecoxib or Rofecoxib.

The active ingredient according to the invention is toxicologically safe, so the invention also relates to administration of a pharmaceutical composition containing an active ingredient according to the invention; and optionally suitable additives and/or auxiliaries or active ingredients, for the treatment of pain, particularly pain due to inflammation.

Suitable additives and/or auxiliaries, in the context of this invention, are any substances known to a person skilled in the art from the prior art for obtaining galenical formulations. The choice of these auxiliaries and the amounts thereof to be used depend on whether the pharmaceutical preparation is to be administered orally, intravenously, intraperitoneally, intradermally, intramuscularly, intranasally, buccally, rectally or topically. Preparations in the form of tablets, chewing tablets, dragees, capsules, granules, drops, juices or syrups are suitable for oral administration, solutions, suspensions, easily reconstitutable dry preparations and sprays are suitable for parenteral, topical and inhalative administration. Suppositories for rectal administration are a further possibility. Administration in a deposit, in dissolved form, in a carrier foil or a plaster, optionally with the addition of agents to promote skin penetration, are examples of suitable percutaneous administration preparations. Examples of auxiliaries and additives for oral administration preparations include blasting agents, lubricants, binders, fillers, mould release agents, optionally solvents, flavouring agents, sugar, in particular carrier agents, diluents, dyes, antioxidants, etc. Waxes and fatty acid esters may, inter alia, be used as suppositories and carrier substances, preservatives and suspension auxiliaries, etc. may be used as parenteral administration agents. The amount of active ingredient to be administered to the patient varies as a function of the weight of the patient, the method of administration and the severity of the illness. The compounds according to the invention may be released after a delay from preparations that may be administered orally, rectally or percutaneously. In the indication according to the invention, suitable retarding formulations, in the form of a “once-daily” preparation that only has to be taken once a day, are particularly preferred.

Also preferred are pharmaceutical compositions containing at least 0.05 to 90.0% of the active ingredient, in particular low effective doses, in order to prevent side effects or analgesic effects. Conventionally, 0.1 to 5000 mg of the combination per kg of body weight, in particular 1 to 500 mg per kg, preferably 2 to 250 mg per kg are administered. Also preferred and conventional, however, is the administration of 0.01 to 5 mg/kg, preferably 0.03 to 2 mg/kg, in particular 0.05 to 1 mg/kg of body weight.

Examples of auxiliaries include: water, ethanol, 2-propanol, glycerol, ethylene glycol, propylene glycol, polyethylene glycol, polypropylene glycol, glucose, fructose, lactose, saccharose, dextrose, molasses, starch, modified starch, gelatine, sorbitol, inositol, mannitol, microcrystalline cellulose, methyl cellulose, carboxymethyl cellulose, cellulose acetate, shellac, cetyl alcohol, polyvinyl pyrrolidone, paraffins, waxes, natural and synthetic gums, acacia gum, alginates, dextran, saturated and unsaturated fatty acids, stearic acid, magnesium stearate, zinc stearate, glycerol stearate, sodium lauryl sulfate, edible oils, sesame oil, coconut oil, peanut oil, soybean oil, lecithin, sodium lactate, polyoxyethylene and polypropylene fatty acid ester, sorbitan fatty acid ester, sorbic acid, benzoic acid, citric acid, ascorbic acid, tannic acid, sodium chloride, potassium chloride, magnesium chloride, calcium chloride, magnesium oxide, zinc oxide, silicon dioxide, titanium oxide, titanium dioxide, magnesium sulfate, zinc sulfate, calcium sulfate, potash, calcium phosphate, dicalcium phosphate, potassium bromide, potassium iodide, talcum, kaolin, pectin, Crospovidon, agar and bentonite.

The pharmaceutical compositions according to the invention are produced using means, devices, methods and processes that are well known in the prior art of pharmaceutical formulations, as described for example in “Remington's Pharmaceutical Sciences”, A. R. Gennaro (ed.), 17^(th) edition, Mack Publishing Company, Easton, Pa. (1985), in particular in part 8, chapters 76 to 93.

Thus, for a solid formulation, such as a tablet, for example, the active ingredient of the pharmaceutical composition may be granulated with a pharmaceutical carrier, for example conventional tablet ingredients such as corn starch, lactose, saccharose, sorbitol, talcum, magnesium stearate, dicalcium phosphate or pharmaceutically acceptable gums, and pharmaceutical diluents, for example water, in order to form a solid composition that contains an active ingredient in homogeneous distribution. The term “homogeneous distribution” is taken to mean that the active ingredient is distributed uniformly over the entire composition, so that said composition may easily be divided into equally effective unit dose forms, such as tablets, pills or capsules. The solid composition is then divided into unit dose forms. The tablets or pills of the pharmaceutical composition according to the invention or of the compositions according to the invention may also be coated or compounded in a different manner, in order to provide a dose form with a delayed release. Suitable coating agents include polymer acids and mixtures of polymer acids with materials such as shellac, cetyl alcohol and/or cellulose acetate.

EXAMPLES

The following examples are intended to illustrate and clarify certain embodiments of the invention, however they are not intended to and should not be understood to limit the subject matter of the invention.

BRIEF DESCRIPTION OF THE DRAWING

The accompanying drawing is a graph showing the effect of (1R,2R)-3-(2-dimethylaminomethyl-cycylhexyl)-phenol hydrochloride (compound no. 1) in the Randall-Selitto test, as well as the supra-additive effective achieved by co-administration with the COX-II inhibitor celecoxib (compound no. 103) in the case of staggered administration. The duration of the antinociceptive effect with the combination of (1R,2R)-3-(2-dimethylaminomethyl-cycylhexyl)-phenol (compound no. 1) and celecoxib (compound no. 103) was also significantly extended. In the combination test, the COX inhibitor was administered perorally to rats 1 hour before the administration of compound no. 1.

Example 1 Effect in the Randall-Selitto Test

The Randall-Selitto test of Randall and Selitto (Arch. Int. Pharmacodyn., 1957, 111: 409 to 419) is a model for inflammatory pain.

By injection of 0.1 ml 20% baking yeast suspension ventrally into a hind paw an oedema was induced, on which pain was generated 4 hours later by continuously increasing pressure with a stamp (2 mm tip diameter). The measured value to be determined and at the same time also the end point of the pain test was the pressure at which the vocalisation reaction of the animal occurred. The percentage maximum possible effect (% MPE) was calculated. The maximum pressure of the stamp was 250 g. The group size was n=10.

The results of the tests may be seen from the accompanying drawing FIGURE and the following table:

Evaluation:

The selected analgesic, (1R,2R)-3-(2-dimethylaminomethyl-cyclohexyl)-phenol (compound 1) in the form of its hydrochloride salt, exhibited a moderately strong to strong inhibition of nociception or hypealgesia in the animal test model.

The theoretical additive value was calculated by adding the mean values from the individual tests of the test substance and COX-II inhibitor. The corresponding standard deviation of the theoretical additive mean value was calculated from the addition of the variances.

The simultaneous administration of a selective COX-II inhibitor celecoxib (compound no. 103) with (1R,2R)-3-(2-dimethylaminomethyl-cyclohexyl)-phenol hydrochloride (compound 1) in the Randall-Selitto test for inflammatory pain, resulted in an intensification of effect in comparison to the theoretically calculated purely additive effect. A clear effect-increasing supra-additive effect is to be highlighted in the case of the staggered administration of COX-II inhibitor and the selected analgesic. In the combination test, celecoxib was administered in the form of the final pharmaceutical composition Celebrex™ one hour prior to the administration of the analgesic.

The results of the tests with (1R,2R)-3-(2-dimethylaminomethyl-cyclohexyl)-phenol are summarized in the following table. Fixed ratio combination=equieffective dose of the two substances, calculated from the ratio of the respective ED50 values. Fixed dose combination=fixed doses of the respective substances.

TABLE Dose of compound % effect/ Ratio of A (1) % effect/ ED₅₀ [mg/kg] % effect/ Compound compound A and COX- % effect/ ED₅₀ of ED₅₀ [mg/kg] No./ (1) to COX- II ED₅₀ [mg/kg] combination of Test combination II- inhibitor [mg/kg] of (theoretical combination (animal (compound A + Method of inhibitor (2) (2) of COX-II additive (experimental model) COX II) administration 1: 2: 1: 2: compound A inhibitor value) value) Fixed dose combination (staggered administration; COX inhibitor 1 hour prior to compound A) Randall- 1 + 103 peroral — — 46.4 215 26.2 8.9 35.1 84.1 Selitto (rat)

The foregoing description and examples have been set forth merely to illustrate the invention and are not intended to be limiting. Since modifications of the described embodiments incorporating the spirit and substance of the invention may occur to persons skilled in the art, the invention should be construed broadly to include all variations falling within the scope of the appended claims and equivalents thereof. 

1. A method of treating or inhibiting pain due to inflammation in a patient in need thereof, said method comprising administering to said patient an effective inflammatory pain alleviating amount of a (1R,2R)-3-(2-dimethylaminomethyl-cyclohexyl)-phenol compound.
 2. A method according to claim 1, wherein the compound is present in the form of a physiologically acceptable salt.
 3. A method according to claim 2, wherein the physiologically acceptable salt is a hydrochloride salt.
 4. A method according to claim 2, wherein the physiologically acceptable salt is a citrate salt.
 5. A method according to claim 1, wherein the compound is present in free base form.
 6. A method according to claim 1, wherein the compound is present in the form of a pure enantiomer or pure diastereoisomer.
 7. A method according to claim 1, wherein said patient is a mammal. 